Healthcare Provider Details

I. General information

NPI: 1417745829
Provider Name (Legal Business Name): PAMELA KWENEOJO OBUTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 04/26/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 FRY RD STE 701
CYPRESS TX
77433-7850
US

IV. Provider business mailing address

21919 CLAY RD APT 6209
KATY TX
77449-2928
US

V. Phone/Fax

Practice location:
  • Phone: 281-815-5033
  • Fax:
Mailing address:
  • Phone: 832-692-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-431076
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: